| NPI | 1841253093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14195) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1962) |
| 111N00000X Chiropractor (Licence: OK 4252) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-04-19 |