| NPI | 1598146714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 11507) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 009236) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2018-02-14 |