| NPI | 1649931841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 14576) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.013816) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2023-11-21 |