| NPI | 1871529404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008605) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2016-01-12 |