| NPI | 1578581120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1552) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-02-20 |