| NPI | 1548658487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1006) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6023) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2015-09-02 |