| NPI | 1396384210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1375) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6630) |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2020-09-21 |