| NPI | 1275525073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3721) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2019-12-13 |