| NPI | 1518060193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7855) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009024) |
| 111N00000X Chiropractor (Licence: WI 05440) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2011-12-30 |