| NPI | 1942590997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5490) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002634A) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2012-06-14 |