| NPI | 1598957649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7814004-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 003607) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2012-09-13 |