| NPI | 1730503004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 963) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5898) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2019-02-25 |