| NPI | 1528269008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3423) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009348) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2009-01-31 |