| NPI | 1366572646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1062) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2608) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2021-07-30 |