| NPI | 1174745178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301003028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556798) |
| 111N00000X Chiropractor (Licence: PA DC010226) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2014-04-17 |