| NPI | 1205838869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 003433) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 00403) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2018-03-17 |