| NPI | 1619421328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010583) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4647) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2022-07-11 |