| NPI | 1831633106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1103) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6291) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2019-07-18 |