| NPI | 1366547960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN DC4112) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: MN DC4112) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2009-08-25 |