| NPI | 1528602836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1413) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6662) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2023-07-27 |