| NPI | 1003401860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401506) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008350) |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2024-09-02 |