| NPI | 1982984969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 10720) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4152) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2023-10-29 |