| NPI | 1164962783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401203) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009787) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2025-01-01 |