| NPI | 1891973848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1515) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9469) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2011-07-26 |