| NPI | 1780057778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008508) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11712) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2025-12-18 |