| NPI | 1295807519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13578) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22871) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-12-06 |