| NPI | 1932262888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 9877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 6079) |
| 225100000X Physical Therapist (Licence: AZ 3667) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2015-06-03 |