| NPI | 1982201018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13337) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010420) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2024-03-14 |