| NPI | 1619046083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR006837) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 7693) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-09-13 |