| NPI | 1659313666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4349) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-04-18 |