| NPI | 1396938023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3127) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch10069) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2013-12-15 |