| NPI | 1366440893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH2867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR001194) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-09-23 |