| NPI | 1871647172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 382340241) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2685) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-07-16 |