| NPI | 1376682526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9567) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2019-02-07 |