| NPI | 1932116399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301007476) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI 7501001411) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-12-11 |