| NPI | 1407966104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301008454) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MI 2301008454) |
| 111NT0100X Chiropractor, Thermography (Licence: MI 2301008454) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-10-25 |