| NPI | 1376597682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2267) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4969) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2014-06-17 |