| NPI | 1124494265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 134387) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010354) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2018-07-05 |