| NPI | 1629567136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH DC-05078) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010680) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-02-27 |