| NPI | 1457464307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009243) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006055) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-06-14 |