| NPI | 1184737116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL Ch-7515) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2014-02-07 |