| NPI | 1215006176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9696) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009225) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2011-05-17 |