| NPI | 1003896309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH15113) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2018030044) |
| 111N00000X Chiropractor (Licence: KS 01-04718) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2025-02-10 |