| NPI | 1881692770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3265) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MN 512) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-04-03 |