| NPI | 1538635073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: FL CH12813) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2025-03-21 |