| NPI | 1053322537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13916) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555634) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-07-17 |