| NPI | 1003926866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11335) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301004801) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-01-12 |