| NPI | 1073681920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 2269) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2444) |
| 111NR0400X (Licence: NC 1532) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |