| NPI | 1568741304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10366) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH10366) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2026-01-16 |