| NPI | 1083921092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556816) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13806) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2023-09-11 |