| NPI | 1790914612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL 15601) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011996) |
| 111N00000X Chiropractor (Licence: GA CHIR008641) | |
| 111N00000X Chiropractor (Licence: MI 2301009583) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2025-08-21 |