| NPI | 1811124712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9725) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4600) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2025-04-01 |