| NPI | 1346247673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC.1699) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301005740) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2013-07-25 |