| NPI | 1649281957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH7173) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL AL1691) |
| 111N00000X Chiropractor (Licence: GA GA005631) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |