| NPI | 1245276302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4667) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12511) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2018-07-23 |