| NPI | 1821381518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH4337) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC2506) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2011-05-27 |