| NPI | 1780727693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 4416) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009316) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2014-01-14 |