| NPI | 1538257472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9389) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011303) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-06-22 |