| NPI | 1063943454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 280668) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12127) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-06-02 |