| NPI | 1902488273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7214) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557740) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-10-22 |