| NPI | 1932120169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MI 2301005078) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301005078) |
| 111N00000X Chiropractor (Licence: MO CE5136) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO CE5136) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2011-09-08 |