| NPI | 1629396205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009757) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60129795) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2011-08-02 |