| NPI | 1578891693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009748) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5293) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2010-12-30 |