| NPI | 1346466182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch9978) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05049) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-03-23 |