| NPI | 1467167528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7181) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301401371) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2024-05-14 |