| NPI | 1295872463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8841) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004843-1) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |