| NPI | 1457782856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11151) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4418) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2016-02-22 |