| NPI | 1407941180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009443) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009781) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-06-23 |