| NPI | 1285656637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2038) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 2444) |
| 111N00000X Chiropractor (Licence: FL 4151) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |