| NPI | 1578797585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5225) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2023-04-13 |