| NPI | 1760796239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10967) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4103) |
| 111N00000X Chiropractor (Licence: GA 8729) | |
| 111N00000X Chiropractor (Licence: VA 0104556937) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2016-03-30 |