| NPI | 1609900802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: MI JE004022) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: FL CH3403) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2015-04-23 |