| NPI | 1689972515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10238) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4527) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2016-01-29 |