| NPI | 1902014251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05117) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2188) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |