| NPI | 1508121609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12749) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: FL CH12749) |
| 111NS0005X Chiropractor Sports Physician (Licence: PR 512) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-05-09 |