| NPI | 1508907742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3513) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 1904) |
| 111N00000X Chiropractor (Licence: DC CH030060) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-08 |