| NPI | 1134628035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007790) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2022-07-06 |