| NPI | 1578598884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH4520) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 0599568) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-09-28 |