| NPI | 1376826164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10331) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6137) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2022-02-17 |