| NPI | 1184132284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14268) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011336) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2023-06-13 |