| NPI | 1295511525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14671) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA85203) |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |