| NPI | 1154499150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch 9393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 994793) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2012-11-26 |