| NPI | 1194338640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401558) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI 7501011856) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2024-10-09 |