| NPI | 1790912954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5109) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2019-07-09 |