| NPI | 1023586047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL Ch13566) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4990) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2023-12-29 |