| NPI | 1215076484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1003) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH007217) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |