| NPI | 1134603798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05281) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010697) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2023-10-02 |