| NPI | 1366518821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9870) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009420) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-03-03 |