| NPI | 1104083195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 23010002905) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009408) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2009-10-21 |