| NPI | 1639235161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00528) |
| 111N00000X Chiropractor (Licence: CA DC-30794) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2019-11-04 |