| NPI | 1992974067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3294) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9509) |
| 111N00000X Chiropractor (Licence: NC 3784) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-07-03 |