| NPI | 1861558926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 9560) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009561) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2012-12-20 |