| NPI | 1902894264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 3024) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4026) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2007-07-08 |