| NPI | 1053509638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5020) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 4026) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2018-08-02 |