| NPI | 1366547069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3066) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN DC3066) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-02-09 |