| NPI | 1518265362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 890) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5557) |
| 171100000X Acupuncturist (Licence: MN 897) | |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2015-02-25 |