| NPI | 1790114049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: MN 6545) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO 0007075) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2019-06-13 |