| NPI | 1235897240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 13829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 14829) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |