| NPI | 1942211347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 10465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 004126442205) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2012-01-23 |