| NPI | 1619051059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3402) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: MN 3402) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |