| NPI | 1639773690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 955) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13319) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2025-08-19 |