| NPI | 1861293748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6315-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301401624) |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-08-28 |