| NPI | 1700808540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6783) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0076271) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-04-23 |