| NPI | 1033285671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 1751) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301004605) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2008-10-02 |