| NPI | 1093099095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16934) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009852) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2026-05-05 |