| NPI | 1235451006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010123) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008615) |
| 111N00000X Chiropractor (Licence: LA 1663) | |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2019-07-22 |