| NPI | 1811477854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA Chir010101) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2020-08-21 |