| NPI | 1871599191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH100034) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8900) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-05-19 |