| NPI | 1699823070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08001879A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301007973) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |