| NPI | 1437101425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5575) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3206) |
| 171100000X Acupuncturist (Licence: CO 721) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2015-12-14 |