| NPI | 1306918354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3967) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1423) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-10-05 |