| NPI | 1891088597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6025) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007428) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2015-02-20 |