| NPI | 1962401661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3017) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A5626) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2013-10-15 |