| NPI | 1265967384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12320) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012948) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2018-03-17 |