| NPI | 1245498096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6742) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011152) |
| 111N00000X Chiropractor (Licence: IA 073329) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2025-09-11 |