| NPI | 1356322671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2441) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006644) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2010-10-12 |