| NPI | 1942638267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5907) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007709) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2016-03-26 |