| NPI | 1811524374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14479) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00769200) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-08-10 |