| NPI | 1578541686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2344) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3879DC) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2009-09-21 |