| NPI | 1558580340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2209618) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2140) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-12-23 |