| NPI | 1659403475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5321) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3862) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2024-02-29 |