| NPI | 1104941228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH11827) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008698) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-08-29 |