| NPI | 1285378117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 14829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4816) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-08-22 |