| NPI | 1750151700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 7165) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2026-01-25 |