| NPI | 1669567624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH11270) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OH 317) |
| 111NX0800X Chiropractor, Orthopedic (Licence: KY 4692) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: PA DC008775) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: OH 2114) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-01-09 |