| NPI | 1609054816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: FL CH9150) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9150) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2015-04-27 |