| NPI | 1265431761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9058) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NC 4334) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2013-08-20 |