| NPI | 1487699724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4657) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3291-012) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2008-08-12 |