| NPI | 1063657435 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9847) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6314) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2011-01-07 |