| NPI | 1336103548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X007694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9812) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2014-02-18 |