| NPI | 1831563469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009707) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010231) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2016-08-11 |