| NPI | 1033394473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10303) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08223) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2025-11-26 |