| NPI | 1275150484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12646) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5383) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: FL CH12646) | |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2022-12-07 |