| NPI | 1407987530 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301007755) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2021-09-08 |