| NPI | 1508868548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2001) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 418) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2012-09-26 |