| NPI | 1598739112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: MI WR009081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009081) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2017-07-19 |