| NPI | 1497194161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH15352) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA68362) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2025-01-17 |