| NPI | 1356557789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2261) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MN 2261) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |