| NPI | 1700016243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5845) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11353) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2014-02-11 |