| NPI | 1043917008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010726) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3676) |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2024-11-25 |