| NPI | 1689678104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8083) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-05-22 |