| NPI | 1194808162 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: MN 2254) | 
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2254) | 
| Enumeration Date | 2006-10-23 | 
| Last Update Date | 2025-09-11 |