| NPI | 1669532156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301002129) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MI 84) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |