| NPI | 1265569339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9637) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010906) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2009-08-18 |