| NPI | 1073685848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 472) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60066746) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2026-03-03 |