| NPI | 1821051699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: FL CH0004296) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NY X3467) |
| 111NN1001X Chiropractor, Nutrition (Licence: NC 3443) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: FL CH0004296) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY X3467) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NC 3443) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2013-01-02 |