| NPI | 1063699205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 9515) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3697) |
| 111N00000X Chiropractor (Licence: SC 3271) | |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2010-09-10 |