| NPI | 1497715569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5083) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8901) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2008-12-03 |