| NPI | 1740665793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557251) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11581) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2020-04-14 |