| NPI | 1093776924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH5424) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1287) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2016-12-23 |