| NPI | 1164575254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 504) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2013-04-17 |