| NPI | 1568485357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 1958) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8162) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-01-30 |