| NPI | 1659659159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MN 2899) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: MN 2899) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-01 |