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 |