| NPI | 1194804112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 075712) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1123) |
| 111N00000X Chiropractor (Licence: WI 3223) | |
| 111N00000X Chiropractor (Licence: MN 3369) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2015-06-08 |