| NPI | 1841214046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1061) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3979) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-08-16 |