| NPI | 1841696374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401559) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 117110) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2024-11-24 |