| NPI | 1730178609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 619) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4519) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2007-07-08 |