| NPI | 1619140522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12946) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011116) |
| 111N00000X Chiropractor (Licence: NJ 38MC00682800) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2023-05-25 |