| NPI | 1457449928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2241) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9184) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2010-01-29 |