| NPI | 1609944354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4214) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008472) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-11-21 |