| NPI | 1467549303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: MN 1921) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: MN 001921) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-09-15 |