| NPI | 1801359187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3228) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6547) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-09-09 |