| NPI | 1578042206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6527) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: MN 6527) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2021-10-28 |