| NPI | 1679798805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH3350) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP3923) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2025-08-07 |