| NPI | 1831215235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR006941) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9331) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |