| NPI | 1366529307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007063) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4766) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-07-16 |