| NPI | 1982704805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 5764) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2008-05-19 |