| NPI | 1942558416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 10600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00703200) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2015-10-12 |