| NPI | 1275945735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5944) |
| 111N00000X Chiropractor (Licence: NE 1910) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2016-10-28 |