| NPI | 1043343965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 005586) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2698) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |