| NPI | 1538102447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 9792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00602100) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-05-04 |