| NPI | 1356624241 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010014) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012038) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2016-11-14 |