| NPI | 1164845657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12093) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557142) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2021-12-22 |