| NPI | 1023781226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14805) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2025-05-09 |