| NPI | 1750686036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5456) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2022-02-17 |