| NPI | 1235414764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10308) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11788) |
| Enumeration Date | 2011-10-16 |
| Last Update Date | 2020-09-09 |