| NPI | 1710983648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch9871) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00553000) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2010-02-04 |