| NPI | 1780346924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12328) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 009965) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2025-12-04 |