| NPI | 1831313980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN MN3613) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3613) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2013-04-01 |