| NPI | 1093256588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6337) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2020-08-20 |