| NPI | 1730537929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6223) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1716) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2019-10-15 |