| NPI | 1851329247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR6851) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008016) |
| 111N00000X Chiropractor (Licence: FL CH9160) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-09-18 |