NPI | 1124186549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4030) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4241) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2020-02-03 |