| NPI | 1124886361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA CHI5140) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14723) |
| Enumeration Date | 2024-03-12 |
| Last Update Date | 2025-06-10 |