| NPI | 1720084015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3860) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4627) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-06-16 |