| NPI | 1194295592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12879) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010131) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2019-08-21 |