| NPI | 1508283649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31993) |
| 111N00000X Chiropractor (Licence: CA DC31993) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2022-11-10 |