| NPI | 1043643414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1238) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5759) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2013-10-29 |