| NPI | 1134358864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 10124) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556688) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2021-11-02 |