| NPI | 1396964565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR001202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH2813) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |