| NPI | 1356684393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12930) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010719) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2019-10-12 |