| NPI | 1619750353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401535) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.014013) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2024-12-20 |