| NPI | 1073051611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010565) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4724) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2022-07-21 |