| NPI | 1235113846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 10396) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301002999) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2012-02-11 |