| NPI | 1821154113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301002932) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 2301002932) |
| 111NX0100X Chiropractor Occupational Health (Licence: MI 2301002932) | |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: MI 2301002932) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: MI 2301002932) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2012-07-09 |