| NPI | 1366496127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 0882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006169) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2014-09-11 |