| NPI | 1922167196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8412) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR 00752) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-02-11 |