| NPI | 1407212210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6175) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 1022) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-01-13 |