| NPI | 1740349190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 2289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301003085) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |