| NPI | 1588990584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11069) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011763) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2015-01-15 |