| NPI | 1831217462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 887) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4016) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2018-05-25 |