| NPI | 1194714782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI sh005066) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2019-01-08 |