| NPI | 1124158167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH10841) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009240) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2013-08-12 |