| NPI | 1902999139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5381) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008364) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-01-17 |