| NPI | 1427459528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5961) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MN 5961) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2023-10-26 |