| NPI | 1801822416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2309) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008766) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2012-10-18 |