NPI | 1972604031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: MI 2301009208) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009208) |
Enumeration Date | 2006-09-25 |
Last Update Date | 2018-08-22 |