| NPI | 1982736609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2654) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ME 761) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-07-09 |