| NPI | 1154574028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor Independent Medical Examiner (Licence: MI 2301007051) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA DC23160) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2016-05-13 |