| NPI | 1457737413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6111) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2015026850) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2016-01-21 |