| NPI | 1760959084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010831) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12368) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2019-11-05 |