| NPI | 1780981936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9428382) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2016-12-09 |