| NPI | 1609364066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010675) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2026-05-05 |