| NPI | 1982847117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3928) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7391) |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2014-01-08 |