| NPI | 1487241030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010466) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2024-04-26 |