NPI | 1528067261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301004340) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MI cb004340) |
Enumeration Date | 2005-07-15 |
Last Update Date | 2023-05-05 |