| NPI | 1669064895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7202) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH61137000) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2024-05-20 |