| NPI | 1902889256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: FL 9104) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: IN 08000588A) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2009-01-26 |