| NPI | 1265989297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010488) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0117234) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2020-07-09 |