| NPI | 1194732768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH4464) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0004464) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-05-05 |