| NPI | 1992769186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH4930) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 3880-1) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2021-02-09 |