| NPI | 1073549143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO07556) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009850) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2012-07-19 |