| NPI | 1497723910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO08495) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8958) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2011-01-19 |