| NPI | 1578650917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5209) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 1100) |
| 171100000X Acupuncturist (Licence: CA 5820) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2009-05-05 |