| NPI | 1528478336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5928) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MN 5928) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2020-06-03 |