| NPI | 1336425420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007456) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5534) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |