| NPI | 1841734852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6316) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 111NOOOOOX) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2021-08-04 |