| NPI | 1326746777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH14415) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA93347) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-09-24 |