| NPI | 1669641452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10815) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3871) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2021-07-27 |