| NPI | 1932676624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 13222504-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12596) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2025-11-24 |