| NPI | 1689383739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7268) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-8000) |
| 111N00000X Chiropractor (Licence: WI 6235-12) | |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2024-12-10 |