| NPI | 1740684794 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 097015) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 097016) |
| 111N00000X Chiropractor (Licence: MN 6464) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2637) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2022-10-03 |