| NPI | 1558304386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2031009153) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009153) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-06-03 |