| NPI | 1275562175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA chir008019) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301007348) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2011-02-16 |