| NPI | 1891724944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301004879) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR002153) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2018-07-17 |