| NPI | 1619927258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2572) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 1418844) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2013-01-15 |