| NPI | 1598733446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1018) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4067) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-06-18 |