| NPI | 1306385497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13439) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2020-07-07 |