| NPI | 1104972660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC0074901) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2016-10-28 |