| NPI | 1598917676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301009554) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10924) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2024-04-11 |