| NPI | 1225179971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 1815) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 401) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2016-12-09 |