| NPI | 1538399258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 2363) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9663) |
| 111N00000X Chiropractor (Licence: NC 4228) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2014-06-04 |