| NPI | 1194812628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3672) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008209) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2019-05-23 |