| NPI | 1801939251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 3046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI RS002625) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2008-04-02 |