| NPI | 1144723545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13049) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA chir010025) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2021-07-26 |