| NPI | 1902298201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301010294) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2015002909) |
| 111N00000X Chiropractor (Licence: PA DC011015) | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2019-07-24 |