| NPI | 1992852511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6552) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4566) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-12-06 |