| NPI | 1104099480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC 2230) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL CH7745) |
| 111N00000X Chiropractor (Licence: FL CH7745) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2010-06-10 |