| NPI | 1194227421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1408) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12400) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2025-05-19 |