| NPI | 1497851372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4682) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-11-19 |