| NPI | 1508015827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5402) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7478) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2008-09-10 |