| NPI | 1962081018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR0008580) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13488) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-03-12 |