| NPI | 1073040754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6407) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0007560) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2018-03-17 |