| NPI | 1437142486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3327) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 575) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2019-09-05 |