| NPI | 1538340989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2923) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3357) |
| 111N00000X Chiropractor (Licence: FL 9774) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2012-01-25 |