| NPI | 1780692004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH4940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038008083) |
| 111N00000X Chiropractor (Licence: MO 2008019907) | |
| 111N00000X Chiropractor (Licence: KS 5138) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2012-04-12 |