| NPI | 1124174909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002422) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301005701) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-12-19 |