| NPI | 1851502306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10080) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556528) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-01-10 |