| NPI | 1154667244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12702) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA 66017) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2023-01-10 |