| NPI | 1376636761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12486) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008934-0) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2019-08-30 |