| NPI | 1831374446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 815) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2016-12-15 |