| NPI | 1679858922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556959) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009809) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2012-02-12 |