| NPI | 1548551187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5527) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 912) |
| Enumeration Date | 2011-05-01 |
| Last Update Date | 2019-05-03 |