| NPI | 1275666000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 4669) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2023-10-12 |