| NPI | 1164976536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010481) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH-14648) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2023-08-22 |