| NPI | 1891720231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 367) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1003) |
| 111N00000X Chiropractor (Licence: MN 4475) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |