| NPI | 1689926214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3585) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH-10718) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2022-05-02 |