| 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 |