| NPI | 1932523172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2746) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 11112) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2022-04-07 |