| NPI | 1295050516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch10733) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009662) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2016-10-25 |