| NPI | 1750529434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3920) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009465) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-02-03 |