| NPI | 1619165461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6076) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4995) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2009-10-14 |