| NPI | 1538324447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL Ch11623) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 01158) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-04-25 |