| NPI | 1154432870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13656) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30201) |
| 111N00000X Chiropractor (Licence: RI DCP00381) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-12-13 |