| NPI | 1861972309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010700) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MI 2301010700) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-12-11 |