| NPI | 1609910884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4747) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2010-08-31 |