| NPI | 1922059435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009686) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4406) |
| 111N00000X Chiropractor (Licence: IN 08002320A) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-08-23 |