| NPI | 1861775199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7026) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1254) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2024-07-08 |