| NPI | 1679600829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: MI 2301008841) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001868A) |
| 111NN1001X Chiropractor, Nutrition (Licence: MI 2301008841) | |
| 111N00000X Chiropractor (Licence: MI 2301008841) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2011-11-06 |