| NPI | 1417367442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3003) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11195) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2018-10-23 |