| NPI | 1891028684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10204) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008524) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2012-05-16 |