| NPI | 1003241407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO009458) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010130) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2015-06-07 |