| NPI | 1336241025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2833) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2024-12-03 |