| NPI | 1861021917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 765) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13253) |
| 225100000X Physical Therapist (Licence: PR 765) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2021-06-17 |