| NPI | 1609207364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6413) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1245) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2021-03-10 |