| NPI | 1043749799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14343) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 225200000X Physical Therapy Assistant (Licence: FL PTA28500) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2026-05-29 |