| NPI | 1851977789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401215) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5621-12) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2022-01-28 |