| NPI | 1518190651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 841) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5211) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2017-02-21 |