| NPI | 1346386802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1241) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 006711) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-08-27 |