| NPI | 1063888923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12888) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11594) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2025-03-05 |