| NPI | 1578623757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3688) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9187) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2015-11-10 |