| NPI | 1750503405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY X009088) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH9290) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-08-23 |