| NPI | 1245871268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6654) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-02-28 |