| NPI | 1548417249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4839) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6779) |
| 111N00000X Chiropractor (Licence: MI 2301009496) | |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2018-03-17 |