| NPI | 1710937495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1006) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3595) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2015-06-15 |