| NPI | 1346567120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8492) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008594) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2010-05-03 |