| NPI | 1861815169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009146) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10727) |
| 133V00000X Dietitian, Registered (Licence: GA LD004157) | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2014-01-23 |