| NPI | 1639594237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11126) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012730) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2023-02-08 |