| NPI | 1174897326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5819) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32188) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2013-09-25 |