| NPI | 1073699526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1833) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4666) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-09-07 |