| NPI | 1487201968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14571) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00764100) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2025-10-08 |