| NPI | 1518055136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1315) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301004847) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-10-24 |