| NPI | 1851975759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000003392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13503) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2021-05-26 |