| NPI | 1669198479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6245) |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2024-06-15 |