| NPI | 1790143220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 110772) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6162) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2022-02-15 |