| NPI | 1760581318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 9248) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2331) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2009-09-28 |