| NPI | 1376864850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6657) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009656) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2016-01-27 |