| NPI | 1366408999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8688) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006540) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2021-10-21 |