| NPI | 1235404393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: MI 2301010136) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0007019) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2024-09-17 |