| NPI | 1972959260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 1001) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2023-07-31 |