| NPI | 1578756847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1163) |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NC 4571) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2017-05-01 |