| NPI | 1558378745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9276) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT19489) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-02-25 |