| NPI | 1356600894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007543) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5667) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2012-09-27 |