| NPI | 1467796375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH 994) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010021) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2017-01-16 |