| 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 |