| NPI | 1811410897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12206) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13239) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2022-12-06 |