| NPI | 1578955944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 5178) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010067) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2025-08-29 |