| NPI | 1225095854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 201129-1) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2017-02-09 |