| NPI | 1154555381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5165) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005900) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2009-05-01 |