| NPI | 1770884546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5624) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31664) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2022-12-07 |