| NPI | 1841568730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH11220) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO 0006965) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2016-02-09 |