| NPI | 1871579714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH8856) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006598) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-01-30 |