| NPI | 1770514713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH9719) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301002841) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-05-16 |