| NPI | 1003499054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 14326) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 16284) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2023-05-09 |