| NPI | 1013149442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MN DC3969) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN DC3969) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MN DC3969) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: MN DC3969) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2022-03-10 |