| NPI | 1578528493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 620) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN DC2991) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-11-09 |