| NPI | 1487637815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH 10850) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 847) |
| 111N00000X Chiropractor (Licence: MI 2301004362) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2013-04-11 |