| 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 |