| NPI | 1871898163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009844) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5269) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2012-12-28 |