| NPI | 1679632830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009220) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MI 2301009220) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2017-12-08 |