| NPI | 1619038775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH0005634) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR004995) |
| 111N00000X Chiropractor (Licence: AL 1523) | |
| 111N00000X Chiropractor (Licence: TN DC0000001066) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |