| NPI | 1245341452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 9188) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 7960) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-11-06 |