| NPI | 1609980457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4532) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7686) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2014-03-10 |