| NPI | 1275866865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5280) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 886) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2019-04-05 |