| NPI | 1710674312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401458) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14505) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-10-06 |