| NPI | 1730424268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009029) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2018-03-17 |