| NPI | 1912205493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11714) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2016-05-26 |