| NPI | 1730424268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009029) |
| 111N00000X Chiropractor (Licence: FL CH11793) | |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2025-03-24 |