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 |