| NPI | 1609254622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401569) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH UW465224) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2025-02-20 |