| NPI | 1790724722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1451) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3187) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-12-14 |