| NPI | 1619057445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301004392) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI CB004392) |
| 111NR0200X Chiropractor, Radiology (Licence: MI 2301004392) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-01-19 |