| NPI | 1164714523 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5531) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MN 5531) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2017-12-12 |