| NPI | 1790012201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 10578) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012022-1) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2012-05-29 |