| NPI | 1619053030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 001104) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 002884) |
| 111N00000X Chiropractor (Licence: FL 0005962) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |