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 |