| NPI | 1629263074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 6984) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 299) |
| 111N00000X Chiropractor (Licence: KY 5400) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2013-07-22 |