| NPI | 1992276927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 29116) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-05-13 |