| NPI | 1649271610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 799) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3957) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-07-16 |