| NPI | 1972662054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OH 3996) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301008837) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2025-12-03 |