| NPI | 1205168630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: FL MM23949) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: FL MM 23949) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2010-02-10 |