| NPI | 1013093129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: MN 2609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2609) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-11-10 |