| NPI | 1740515923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3151) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH10017) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2021-08-10 |