| NPI | 1851918858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010991) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: MI 2301010991) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR010365) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-10-06 |