| NPI | 1316966104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A5632) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 1630) |
| 111N00000X Chiropractor (Licence: WI 1541) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |