| NPI | 1346358785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009218) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011071) |
| 111N00000X Chiropractor (Licence: MI JB009218) | |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2015-08-20 |