| NPI | 1396894135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007415) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8061) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-11-09 |