| NPI | 1669662912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 8207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5047) |
| 111N00000X Chiropractor (Licence: MN 5008) | |
| 133N00000X Nutritionist (Licence: MN N200) | |
| 163W00000X Registered Nurse (Licence: MN 2377210) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2021-05-25 |