| NPI | 1417032061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: MN DACRB) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3155) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-09-11 |