| NPI | 1619040144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9106) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR006551) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-09 |