| NPI | 1669937314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010758) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2021-10-20 |