| NPI | 1982079976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12219) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6141) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2022-07-21 |