| NPI | 1215327721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6957) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR0007230) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2022-12-06 |