| NPI | 1649309204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH 10606) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3487) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2019-01-25 |