| NPI | 1750397212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11175) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8993) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-05-14 |