| NPI | 1215699152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH15913) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR066678) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL6783) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT004374) | |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2026-04-28 |