| NPI | 1215019922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3356) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 525) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-01-04 |