| NPI | 1699553982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14913) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR011051) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-08-12 |