| NPI | 1649222399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2091) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3908) |
| 111N00000X Chiropractor (Licence: FL 2107) | |
| 111N00000X Chiropractor (Licence: IA A05962) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |