| NPI | 1639340342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3171) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2401) |
| 111N00000X Chiropractor (Licence: CO 5028) | |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2010-07-08 |