| NPI | 1427384544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009549) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008424) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2016-03-22 |