| NPI | 1013745678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 1091) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14734) |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2025-10-10 |