| NPI | 1619021839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 8701) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008178-1) |
| 171100000X Acupuncturist (Licence: NY 002077-1) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2022-09-06 |