| NPI | 1093891855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3929) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 587) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-02-08 |