| NPI | 1720304702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002490A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9935) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2011-01-13 |