| NPI | 1275646697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009115) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3611) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-06-23 |