| NPI | 1629039128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH0006378) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1355) |
| 111N00000X Chiropractor (Licence: SC 1517) | |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2011-11-10 |