| NPI | 1386844777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2226) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8025) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-05-04 |