| NPI | 1093396616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 112360) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6834) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2023-03-22 |