| NPI | 1295512127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 930) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH-12706) |
| 363AM0700X Physician Assistant, Medical (Licence: PR 003074-P.A.) | |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2026-04-27 |