| NPI | 1336118181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 667) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2108) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2008-09-23 |