| NPI | 1902539547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1357) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13882) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2023-01-25 |