| NPI | 1528083235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5584) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 10646) |
| 111N00000X Chiropractor (Licence: MI 2301007729) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-02-07 |