| NPI | 1528536901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13211) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010129) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2023-07-07 |