| NPI | 1346645348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6170) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012670) |
| 111N00000X Chiropractor (Licence: IN 08002780A) | |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2026-06-11 |