NPI | 1982622874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH8900) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011485) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2015-08-26 |