| NPI | 1316091598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH-0007372) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006-0001027) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-05-01 |