| NPI | 1942349915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30960) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009304) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2009-08-06 |