| NPI | 1215616149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH14605) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14605) |
| 111NN0400X Chiropractor, Neurology (Licence: VA 0104557920) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: FL CH14605) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-05-07 |