| NPI | 1619072790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 11802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3163) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-06-29 |