| NPI | 1568944064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12562) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: FL 12562) |
| 111NN1001X Chiropractor, Nutrition (Licence: FL 12562) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: FL 12562) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2026-05-16 |