| NPI | 1073742292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9863) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO008441) |
| 171100000X Acupuncturist (Licence: FL Acupuncture cert.) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2011-05-27 |