| NPI | 1003148842 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5264) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5466) |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MN 877) | |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2018-10-27 |