| NPI | 1376325951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 966) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH-14740) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2025-07-02 |