| NPI | 1376696252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 1176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006746) |
| 111NN1001X Chiropractor, Nutrition (Licence: OH 1176) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-09-11 |