| NPI | 1245317148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104555805) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13828) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-11-09 |