| NPI | 1598752859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: MN 1818) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 1818) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-02-06 |