| NPI | 1063984235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003220A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010916) |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2021-11-03 |