| NPI | 1699435461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7220) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557779) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2024-06-18 |