| NPI | 1124089339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4356) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI KKOO5272) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-02-07 |