| NPI | 1528828571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH15240) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 112412) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-05-16 |