| NPI | 1184604969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5842) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6610) |
| 111N00000X Chiropractor (Licence: WI 4414-12) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2025-01-13 |