| NPI | 1043867641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4889) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010749) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2025-07-08 |