| NPI | 1326027533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN MN002998) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN MN2998) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2023-12-05 |