| NPI | 1881942332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH10999) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 12114) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2013-10-01 |