| NPI | 1932832979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH13861) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA86116) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2023-04-11 |