| NPI | 1639336266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6061) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001075) |
| 111N00000X Chiropractor (Licence: NY X0057711) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |