| NPI | 1134690456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 105158) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6546) |
| Enumeration Date | 2018-12-14 |
| Last Update Date | 2020-11-20 |