| NPI | 1174750632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6667) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009571) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2011-08-09 |