| NPI | 1013071943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 508) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3363) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2013-01-28 |