| 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 |