| NPI | 1164579132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8132) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5781) |
| 111N00000X Chiropractor (Licence: TX 8007) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-06-10 |