| NPI | 1760440788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH6625) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2061) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-11-23 |