| NPI | 1154910339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 14043) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3714) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2024-02-26 |