| NPI | 1497077127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557101) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9897) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2013-10-16 |