| NPI | 1386999100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11734) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4276) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2016-06-30 |