| NPI | 1194865626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009294) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI TW009294) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-01-03 |