| NPI | 1194780601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10161) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2011-12-16 |