| NPI | 1689751232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5201) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5048) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-11-24 |