| NPI | 1295155943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10790744-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11153) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2019-07-08 |