| NPI | 1205044708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH7825) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 5740) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |