| NPI | 1205955549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR006698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 8106) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |