| NPI | 1376563619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10075) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR007926) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2016-08-15 |