| NPI | 1992461123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MI 2301401165) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13525) |
| 111N00000X Chiropractor (Licence: KY 271416) | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2021-11-11 |