| NPI | 1245508720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6786) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2013-09-24 |