| NPI | 1083739445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8854) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: FL CH8854) |
| 111NR0400X (Licence: FL CH8854) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2009-04-27 |