| NPI | 1710147251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH10347) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011645-1) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2018-01-08 |