| NPI | 1083943351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4059) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch9859) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2010-12-13 |