| NPI | 1376540468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8450) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010232) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2010-11-23 |