| NPI | 1003985227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9324) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-30080) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2015-03-25 |