| NPI | 1629439799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH 6224) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8072729-1202) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-03-16 |