| NPI | 1629019195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4719) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MN 871) |
| 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: MN 196755) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-03-17 |