| NPI | 1295052983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009012) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008320) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2010-12-14 |