| NPI | 1750468336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 9208) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC002482) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-04-17 |