| NPI | 1366538639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104000770) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301004844) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-08-07 |