| NPI | 1932385580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12257) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 14564) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC11454) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW004131) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2018-07-26 |