| NPI | 1730129677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 2224) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 238) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-07-30 |