| NPI | 1447452982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5172) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2016-11-15 |