| NPI | 1386397107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0005693) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13290) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |