| NPI | 1679214084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16566) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14005) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-12-05 |