| NPI | 1295931673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3784) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009228) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2008-01-07 |