| NPI | 1659355006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 003031) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 1107) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2025-07-17 |