| NPI | 1417956863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6359) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO003117) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2011-10-03 |