| NPI | 1043831225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7187) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 11698237-8007) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-10-01 |