| NPI | 1154567766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CFC16) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001199) |
| 111N00000X Chiropractor (Licence: RI DCP00282) | |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2014-02-14 |