| NPI | 1477929230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010353) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5132-12) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2016-12-20 |