| 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 |