| NPI | 1396968947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2743) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 1130953) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |