| NPI | 1154432565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1177) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH6102) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-12-11 |