| NPI | 1851747505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7240) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO010509) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002922) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2024-05-28 |