| NPI | 1891075040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009804) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MI 1992207) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2015-11-09 |