| NPI | 1275045601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010571) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-04764) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2021-10-06 |