| NPI | 1265435812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 1888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5776) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-01-26 |