| NPI | 1164544474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301007363) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 572) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |