| NPI | 1265409312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4875) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 8050) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2016-03-30 |