| NPI | 1699704221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2646) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8427) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-01-29 |