| NPI | 1881355972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 6927) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MN 6927) |
| Enumeration Date | 2022-01-01 |
| Last Update Date | 2023-09-06 |