| NPI | 1962092494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 7129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 1139) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2023-10-20 |