| NPI | 1144413832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60022332) |
| Enumeration Date | 2007-08-25 |
| Last Update Date | 2010-03-19 |