NPI | 1679649610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4982) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06908) |
Enumeration Date | 2006-11-28 |
Last Update Date | 2024-03-05 |