| NPI | 1861802530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12555) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2014013287) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-06-04 |