| NPI | 1649239161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2034) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 223) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2014-09-22 |