| NPI | 1326040676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1070) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3464) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2018-03-17 |