| NPI | 1043339765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301005392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC03333) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |