| NPI | 1255415071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIROO6565) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH6732) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-03-03 |