| NPI | 1730737529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008825) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010837) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2024-08-21 |