| NPI | 1508497074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 119669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6709) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2023-12-13 |