| NPI | 1255666970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2373) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2015-05-13 |