| NPI | 1326035866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08000842A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI L557686) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |