| NPI | 1508903964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 9966) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4741) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-10-14 |