| NPI | 1821468471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 5794) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MN 5565) |
| 111N00000X Chiropractor (Licence: IA 007651) | |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2015-12-30 |