| NPI | 1972714434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007620) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10860) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2014-06-16 |