| NPI | 1215995741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH0004610) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT0002352) |
| 225100000X Physical Therapist (Licence: CT PT002252) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-11-27 |