| NPI | 1104605666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 14755) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-11-05 |