| NPI | 1124430301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11519) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MO 2014015330) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2016-05-12 |