| NPI | 1679615389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2328) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 002328) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-03-01 |