| NPI | 1447618962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13575) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012573) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2022-06-20 |