| NPI | 1225499205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch12182) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012724-1) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2017-05-10 |