| NPI | 1871919530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 072381) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2019-10-08 |