| NPI | 1760511752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 953) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4693) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-03-15 |