| NPI | 1043020670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7351) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1503) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-07-17 |