| NPI | 1831194281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2374) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4347) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2011-05-31 |