| NPI | 1043373343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009361) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC4634) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-02-17 |