| NPI | 1700163516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5787) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4194) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2013-06-03 |