| NPI | 1104966159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9260) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2014-03-18 |