| NPI | 1154891026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 14560) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL 46183) |
| 171100000X Acupuncturist (Licence: FL 4006) | |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2023-06-07 |