| NPI | 1619086774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH4184) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO CH4014) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |