| NPI | 1710085576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2067) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3932) |
| 111N00000X Chiropractor (Licence: WI 1916-012) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |