| NPI | 1194712091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 552) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3041) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2024-06-01 |