| NPI | 1578876108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11673) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA33745) |
| Enumeration Date | 2010-07-25 |
| Last Update Date | 2025-01-28 |