| NPI | 1104018183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5228) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3776) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2010-06-04 |