| NPI | 1881815710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301008046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4289) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-11-16 |