| NPI | 1699869446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301008030) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NM 664) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |