| NPI | 1386609402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH2834) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP070) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2015-05-04 |