| NPI | 1558618090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002608A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010118) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2014-10-16 |