| NPI | 1730533274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12715) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4616) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2024-11-05 |