| NPI | 1467445817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN MN3465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 8001749) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2011-01-26 |