| NPI | 1205139904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 10187) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012251) |
| Enumeration Date | 2010-12-19 |
| Last Update Date | 2013-02-04 |