| NPI | 1457573677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12195) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301005183) |
| 111N00000X Chiropractor (Licence: AZ 4128) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-12-03 |