| NPI | 1548355787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5017) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 542) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-06-11 |