| NPI | 1811330681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3925) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301010007) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2024-09-08 |