| NPI | 1588325260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6236) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13851) |
| 111N00000X Chiropractor (Licence: OR pending) | |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-09-07 |