| NPI | 1992821078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: SC 3661) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI L766087) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2011-09-29 |