| NPI | 1679503981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: PA 2746) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: AZ 7366) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-11-28 |