| NPI | 1982933412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL Ch11021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000002345) |
| 111N00000X Chiropractor (Licence: VA 0104557279) | |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2017-03-17 |