| NPI | 1508524943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010928) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13821) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2023-09-20 |