| NPI | 1467245654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH15509) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR066658) |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2026-05-20 |