| NPI | 1497172563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010262) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002755A) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2020-06-29 |