| NPI | 1790894582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13833) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI AA007538) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2018-08-01 |