| NPI | 1942261136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 002902) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 526) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2021-03-11 |