NPI | 1508239039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010433) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2015013785) |
Enumeration Date | 2015-11-05 |
Last Update Date | 2022-03-25 |